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Five Important Business Lessons I Learned from Developing Country Public Health Professionals

March 07, 2017 | Sharon Rudy, Global Health Fellows Program II | This post first appeared on the Global Health Fellows Program II blog.

Pictured: Sharon Rudy (left), GHFP-II Program Director, welcomes students at the Global Health Youth Summit.
Pictured: Sharon Rudy (left), GHFP-II Program Director, welcomes students at the Global Health Youth Summit.

You might say I stumbled into my dream job. Although I was an exchange student in college, I never meant to end up in an international career (and certainly not advising about careers!).

I spent my senior year in The Netherlands where I thought I was really roughing it—little did I know what lay ahead. In fact, I can remember praying that I NOT be called to the “Mission fields” overseas. I felt a bit guilty about it, but I just never wanted to be uncomfortable.

After a few years of working in low-level administrative jobs in hotels, law firms, retail, and a yacht brokerage, I was so ready for graduate school to open all the doors. With a new Masters and Ed.S degree in Counseling, I just needed to work and wasn’t looking for an international setting. However, I unknowingly clinched the deal when an interviewer from an international exchange program asked me what I had learned from living abroad. I said, “What it means to be an American.” That was, evidentially, a brilliant answer.

I got the job and spent the first 15 years of my professional life working in international exchange with a deep focus in cross-cultural adaptation, à la the Peace Corps. My PhD dissertation was on how Americans adjust to cultural change and I’ve always felt strongly that in all the jobs I’ve had, good relationships are just as critical as technical expertise. In fact, as the Director of USAID’s flagship global health fellowship program, when I've had to fire an underperforming fellow, it has rarely been about technical skill. More often, problems come from their inability to connect with their team, their clients, or their colleagues.

It’s strange to me that when I started working in international development almost 30 years ago, everyone just assumed you were culturally competent and were happy to throw you into an environment that requires the highest levels of cross-cultural know-how. GHFP-II’s research, conducted with almost 50 global health employers, underscores the wide gap between the in-demand skills needed to succeed in global health and those being taught in the classroom.

One skill cluster is the ability to thrive in a multi-cultural environment, take in new information, and adapt to your circumstances.

Here are five key lessons I learned from the patient, long-suffering developing country public professionals, including USAID Foreign Service Nationals (FSNs), who took pity upon me and showed me the ropes:

  1. When you begin work as a technical adviser, your two immediate overriding objectives should be to establish trust and to demonstrate that you can add value. Seek first to understand by practicing active listening. Their country interests override anything else so try to identify what those interests are. Don’t be afraid to show initiative in learning the full truth. Initially, they may only be telling you what they think you want to hear.
  2. Practice humility. A lack of humility destroys trust. Don’t assume you know more than your host counterpart. You will never know all the answers, so it is the attitude of empathetic awareness that allows mistakes to be forgiven. It’s not about you proving yourself with a barrage of data and other-country stories. Don’t try to establish the relationship by showing off your expertise and knowledge, especially by going quickly to the solution. This will result in a quiet “sigh” from your colleagues that you might not even notice in your hurry to fix things. Trust me, you aren’t the first American who has come their way, ready to fix everything, and you probably won’t be the last. Instead, find a way to balance the power and privilege that is reflected in your being an American, with access to American institutions and American resources, with an acute awareness and a learner’s heart.
  3. Be their champion. Although complete “country ownership” rarely happens, it has to be an authentic, high priority for you. This means you are coming into the relationship with a focus on a post-“you” environment. Remember, it’s their country, not yours. Decisions will stick only if they truly own them. In communication about your work, promote the real picture of your host countryit usually differs from international media stories. Be generous about helping your local counterparts make connections with the international community and make available all your “secret” resources and technical knowledge. This is a joint venture with peers, so start it with a sense of mutual respect and a culture of sharing. Value local talent and make the best use of it to make your work more meaningful and sustainable.
  4. Respect the culture. Make efforts to understand local norms, culture, and traditions. Seek to understand how people approach key issues in their daily life. No culture is a monolithic construct, but rather an intricate web of narratives. For example, in most cultures, family importance can’t be overstated, so don’t blow off dinner with your new colleagues so you can send emails. Even though USAID is an American agency, and local public health professionals, including the FSNs, have adapted to that reality, the most important things are happening outside the compound. Cultural competence is never a “checklist” and, admittedly, you can never learn everything about the culture, history, and politics of the country you are involved in, but honest efforts will be noted and appreciated.
  5. Solutions must be contextualized within existing systems and structures. Don’t assume you have the answer even if you easily see all the things that are wrong. Seek to cause change in slow, measured steps to avoid negative or unintended consequences. Don’t offer solutions without understanding host country systems. Remember, not everything local needs to changethere are best practices already in place in your host country. And don’t assume that modern technology will magically fix everythingcontext and environment matter.

So, thank you to my developing country public health professional colleagues for being too dignified to criticize, for your patience with us as we come and go in your country, and for your generosity of spirit and forgiveness of my many mistakes over the years! I have learned so much from you, and continue to, even to this day.

Please add your thoughts to the conversation by Tweeting or posting your tips, best practices or anecdotes on social media. What have been your biggest “aha!” moments working with professionals outside the U.S.? Let us know on Twitter @ghfpii using the #AHAmomentinGH hashtag!


Sharon Rudy, PhD, directs the Global Health Fellows Program (GHFP) under a cooperative agreement with the U.S. Agency for International Development.